Drug Shortage Affecting Lawrence and the Nation

There is a growing shortage of pharmaceutical drugs and it’s affecting patient care in Lawrence and the rest of the country.

Patients are receiving alternative treatments that are less than ideal, treatments are being delayed, and in worse-case scenarios there are no treatments available.

Erin Fox, a drug shortage expert, said we are in a health care crisis.

“It’s not just happening in rural places. It’s not just happening in small hospitals. This is impacting just about every hospital across the United States,” she said in a recent telephone interview.

Fox is the manager of the Drug Information Service at the University of Utah Hospitals and Clinicsin Salt Lake City. The service monitors and verifies shortages for the American Society of Health-System Pharmacists.

So far this year, she said there are 213 drugs in short supply. That’s triple the 70 drugs reported five years ago. About 80 percent of the shortage is injectable drugs.

“The big blockbuster drugs aren’t the ones that are experiencing shortages. It’s things we need for surgery. Things that we’ve used for 20 years,” she said.

Among them are Fentanyl, a pain reliever that is used frequently in operating rooms and intensive care units, and Labetalol, which is used to treat high blood pressure.

The American Hospital Association surveyed 820 hospitals in June and 99 percent of them reported that they had experienced a shortage in the previous six months and nearly half of them reported 21 or more drug shortages.

Hitting Home

Pat Parker, director of Pharmacy & IV Therapy at Lawrence Memorial Hospital, told the board last week that the shortage is affecting them as well. He has been in the pharmacy business for 35 years and hasn’t seen a shortage like this one.

“This is a big deal. It really is,” he said.

Parker said the pharmacy department was tracking about 30 products last week that were in short supply and at risk of running out.

He said most of the drugs that have been in short supply are used for sedation, emergency care and cancer chemotherapy. He said there’s also been a shortage in simple electrolyte products that they use “day in and day out” and they typically cost a couple of dollars a vial or less. The products are mixed with others and given to patients intravenously to make sure a patient is stabilized.

“We literally can’t get those right now,” he said.

Like other hospitals, LMH doctors and pharmacists use the next best alternative when one runs out.

“It’s not ideal, but it’s what we do,” he said.

Switching medicines is not as easy as one might think because of an electronic system that’s set in place for patient safety. Everything has bar codes and there are automated dispensing machines. It can take two to three days to switch out a drug. Of course, there are ways to get drugs to a patient in an emergency situation, but it won’t necessarily have all of the safety checkpoints.

“Usually these supply issues are coming to us when we have some stock available, so we usually have a few days to react to them,” Parker said.

Pat Hubbell, pharmacist and co-owner of Sigler Pharmacy in Lawrence, said he’s dealing with a shortage of Adderall which is used for attention deficit hyperactivity disorder.

“We’ve been through everything on Adderall and have patients who are unable to get it or if they’ve switched to an alternative, they are really expensive and patients can’t afford it.”

He said the generic tablets for Adderall have quadrupled in price and insurance companies aren’t responding to the markup which is frustrating for him and customers.

Hubbell added that they recently had a customer from Independence, Mo., who was having trouble finding a particular medicine that Sigler just happened to have in stock.

“There’s something going on. I don’t know exactly what it is,” he said.

Common Causes

Fox said the main reason for the shortage is fewer companies are making the drugs and these companies have had manufacturing problems and have had to shut down production. She said two of the largest companies experienced manufacturing issues at the same time. About half of the manufacturing issues have been due to quality; they just weren’t meeting new stricter Food and Drug Administration regulations.

“There hasn’t been enough resiliency in the supply chain to make up the difference,” she said.

The economy also is to blame. Like other businesses, pharmaceutical companies are cutting back or shutting down production lines that aren’t making money.

“If it’s not profitable to make them, they don’t. It’s business,” she said.

Sometimes, Fox said, there are raw material issues.

Another problem, Parker said, is the “gray market.” He said there are groups of people stocking up on drugs that they think will be in short supply because of, for example, an FDA citation. Then, they sell the products at higher costs.

Research by Premier, a North Carolina-based alliance of hospitals and health care sites, looked at 42 hospitals over a two-week period earlier this year and found that there were 1,745 offers from the “gray market” providers. The average markup was 650 percent.

Parker said LMH purchases its drugs through a buying group and a wholesaler. It will spend about $12.5 million this year. He said LMH is notified when there might be a problem which prompts them to “stock up.” Parker said hospitals will share products in a pinch.

“It’s all about patient care, believe it or not. We are competitors with the folks that are east and west of us, but when it gets right down to it, we are all about taking care of patients,” he said.

Cancer Drugs

Fox said the top three drug classes that are experiencing shortages nationwide are central nervous system, antibiotics and chemotherapy. There are 22 chemotherapy drugs on the shortage list.

“It’s hard enough to have cancer but also to be told that the medicine that you need is not available would just be awful,” Fox said.

Dr. Luke Huerter, an LMH oncologist, said he was concerned about a possible shortage of a drug called Paclitaxel and took that into consideration when developing a patient’s course of treatment. The hospital has received a shipment and now has enough to take care of patients through December.

“It’s always something that’s always kind of at the back of our minds because at certain times we’ll hear from our manufacturer that we won’t potentially be able to get the supply that we need,” he said.

Fox said there are legislative activities under way to help alleviate the drug shortage.

“I’s a really complex problem and there’s no one solution that’s going to solve the problem,” she said.

DRUG SHORTAGES

Here’s a look at the number of drug shortages in the past five years, according to the University of Utah Hospital’s Drug Information Service. So far this year, there are 213.

• 2006 — 70.

• 2007 — 129.

• 2008 — 149.

• 2009 — 166.

• 2010 — 211.

Here are the top five drug classes that are experiencing shortages and how many drugs are in short supply:

• Central Nervous System — 38.

• Antibiotics — 23.

• Chemotherapy — 22.

• Cardiovascular — 15.

• Autonomic — 13.

LMH PHARMACIST TO PARTICIPATE IN CHAT

Pat Parker, director of Pharmacy and IV Therapy at Lawrence Memorial Hospital, will be available Wednesday to discuss the national drug shortage and how it is affecting the hospital and patients.

Parker will be participating in an online chat at 10 a.m. Oct. 26 on WellCommons.com. And, you can submit your questions anonymously at anytime at WellCommons/chats. Make sure to log back to WellCommons.com either during or after the chat to see if your questions were answered.

Parker has been director of pharmacy at LMH since 1984 and also directed the oncology unit from 2001 to 2004. He is adjunct clinical professor of pharmacy practice with Kansas University’s School of Pharmacy.

He is an active member of the American Society of Health Systems Pharmacists and the Kansas Council of Health Systems Pharmacists. He has served on the Kansas Board of Pharmacy.

He also has helped organize medical mission trips to impoverished regions of Kenya where AIDS is prevalent.

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